Two of the most important things to know when deciding on which med is the best for a particular condition1: how likely is it to work and how long will it take.
The odds of a med working for a particular condition and how long it generally takes to work should be fairly easy to nail down, and not need to be summed up by the Internet shorthand YMMV (Your Mileage May Vary). Aside from it being hard enough to get an accurate diagnosis when brain cooties are involved, why is it so difficult to figure out if Lexapro is right for you and how long it will take for you to know that?
Because no one is quite sure exactly what causes various conditions.
Which is further complicated when everything is a spectrum disorder (e.g. bipolar 1, bipolar 2, all the others planned for DSM-V).
You should still give it at least three weeks, unless the side effects hit hard, fast, and don’t start getting better within two weeks of reducing the dosage (if there’s any room to reduce the dosage).
3. How Effective Lexapro (escitalopram) is for its Approved Uses
3.1 Major Depressive Disorder (MDD)
The odds are pretty good that Lexapro will work for MDD, as in you have a 60–75% chance that you’ll respond to Lexapro3 - i.e. it will do something positive - and a 60–70% chance of remission, i.e. your MDD symptoms will more-or-less go away and stay away, although you may have to keep taking your meds to ensure you stay symptom-free.
Keep in mind that:
Serotonin reuptake inhibition, and everything else SSRIs do, is not the answer for everyone, either by itself or at all.
When you pool all the data together (see below) you’ll find that Celexa and Lexapro are better than the other SSRIs. It’s marginally statistically significant for everyone who still takes the other SSRIs. Their real advantage comes from sucking less than the others and being better at preventing relapses, so if you and your doctor think you’re going to be depressed forever without meds, you’re way better off with Celexa or Lexapro than another SSRI or other antidepressant.
Unlike most antidepressants I was actually able to find the clinical trials on PubMed, although there are no more data in the abstracts than in the PI sheet. Except for Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. The discrepancies between the PI sheet and the abstract that are really telling. The US PI sheet, which doesn’t allow you to copy any text, has the typically vague result of “statistically significant greater mean improvement compared to placebo on the MADRS.” But when you look at the study:
Clinical response was evaluated by the Montgomery-Asberg Depression Rating Scale (MADRS), the 24-item Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions (CGI) scales, the Hamilton Rating Scale for Anxiety (HAM-A), and patient-rated quality-of-life scales.
RESULTS: Escitalopram, at both doses, produced significant improvement at study endpoint relative to placebo on all measures of depression; significant separation of escitalopram from placebo was observed within I[sic] week of double-blind treatment. Citalopram treatment also significantly improved depressive symptomatology compared with placebo; however, escitalopram, 10 mg/day, was at least as effective as citalopram, 40 mg/day, at endpoint. Anxiety symptoms and quality of life were also significantly improved by escitalopram compared with placebo. The incidence of discontinuations due to adverse events for the escitalopram 10 mg/day group was not different from the placebo group (4.2% vs. 2.5%; p = .50), and not different for the escitalopram 20 mg/day group and the citalopram 40 mg/day group (10.4% vs. 8.8%; p = .83).
Which is a better predictor: Omega-3 fatty acids (O3FA) or how neurotic you are? So if Woody Allen eats a lot of fish, would that mess up the study? The results: however much O3FA you have floating around won’t give you clue whether or not Lexapro may work for you, and while treating anxiety and depression at the same time is always difficult, following the usual Crazy Meds titration schedule of low dosages with no target dosage allows Lexapro to work rather well for the combination.
3.2 Generalized Anxiety Disorder (GAD)
The story for anxiety disorders is a bit better. People in the Panic/Anxiety community love Lexapro. Like MDD efficacy rate is still around 70–75%, but as GAD (and many of the other anxiety disorders for which it’s used off-label) tends to respond at lower dosages than MDD, the side effects tend to suck a lot less than GAD and other treatments.
In regards to GAD, this double-blind study of 158 people taking Lexapro vs. 157 people taking placebo had 68% of the people taking Lexapro responding against 41% taking the placebo. Not too bad for the placebo. In Lexapro’s favor, though, on the Hamilton Rating Scale for Anxiety, those taking Lexapro averaged a 11.3 point drop from a score of 18 points or higher, whereas those taking the placebo dropped only an average of 7.4 points. So you can fool some of the people with GAD into feeling better, but even those you fool won’t feel better than they could have with a real med.
What looks like a follow up to the clinical trials for Lexapro’s approval for GAD has even better numbers than the above. Those who completed the 8-week double-blind trials were given the option of knowing they were taking Lexapro (escitalopram oxalate) 56% of the people made it to the end, so about half in all, or roughly 250 people were still helped by Lexapro (escitalopram oxalate) for generalized anxiety disorder (GAD), and helped a lot.
Just like with MDD, Lexapro helps to prevent the relapse of generalized anxiety disorder. At least when compared with placebo. After taking Lexapro for 8–12 weeks:
In this study Only 19% of the people taking Lexapro had a relapse of symptoms compared with 56% of those who got the placebo.
4. Likelihood Lexapro (escitalopram) will Work for Off-Label Applications
4.1 Panic-Anxiety Disorders other than GAD
Except for hoarding, where you’ll want Paxil, Lexapro may as well be approved for the rest of them. Oh, wait, Lexapro is approved to treat other anxiety disorders, just not in the US. We really need a way to streamline the approval process for meds when they’re already available here and approved for something else in practically every other country on the planet. In any event…
Panic disorders (PD), with or without agoraphobia: Unlike OCD, these aren’t all over the map. Lexapro has a good 60–70% chance of working for you regardless of the type of PD you have.
PTSD - unfortunately there just aren’t enough data for Lexapro and Celexa for either combat or non-combat PTSD to give you any odds. SSRIs are used to treat both combat and non-combat PTSD all the time, so you may as well try it.
5. Lexapro (escitalopram) versus Other Antidepressants for its Approved Indications
Lexapro vs. Celexa. This is one of the most asked questions we get when it comes to comparing meds, and it should be. Is there a real difference in efficacy between Lexapro and Celexa? Even though Lexapro works faster the real difference is in the long run, because Lexapro sucks a little less. So more people take Lexapro for a longer time, but the difference is such that it matters only individuals and national healthcare systems.
Cipralex vs. Cipramil in outpatients with depression. A Lundbeck-sponsored trial. 20mg of Cipralex/Lexapro vs. 40mg of Cipramil/Celexa. The results: Lexapro worked better (76% response rate, 61% remission rate vs. 56% and 43% for Celexa), and while both didn’t suck all that much, Lexapro sucked even less (4 out of 138 quit taking Lexapro due to side effects vs. 9 out of 142 for Celexa).
Cipralex vs. Cipramil for depression treated by primary care physicians. Another Lundbeck-sponsored trial. 10mg of Cipralex/Lexapro vs. 20mg of Cipramil/Celexa. The results: A little odd. At the end of 8 weeks Lexapro had a 63% response rate and 55% remission rate vs. Celexa’s 55% and 45%, by week 24 Lexapro had an 80% response rate and 76% remission rate vs. Celexa’s 78% and 71%. The odd part is both meds were way more effective for the moderately depressed than the severely depressed at week 8, and Lexapro was barely more effective for the moderately depressed at week 24. This runs counter to all the studies showing meds to be more effective for the severely depressed. But there are always studies with atypical results.
Lexapro vs. Celexa - which is worse to overdose on? This is actually an interesting question, as only critters have been given more than 60mg of Lexapro. Does the two-to-one dosage ratio of Celexa to Lexapro hold up when you take an entire bottle? How much difference does the r-enantiomer of Celexa make? The results: Celexa is more toxic than Lexapro, but, like all SSRIs, it’s next to impossible to kill yourself with them. Although the median dosage of Celexa was higher (310mg vs. 130mg for Lexapro. The equivalent dosage of Celexa would be 260mg.), it’s hard to tell by how much that skewed the results. The most striking was the incidence of seizures, 30 for Celexa vs. 1 for Lexapro.
Lexapro vs. nortriptyline for various aspects of depression. It’s kind of hard to tell if Lundbeck and GSK had any real influence on this study. In any event the results were: it depends on what is making you depressed. If you need to feel better about yourself, stop having to drag yourself out of bed and from one place to another, and need to know things will get better, then Lexapro is the better drug. If you need to sleep at night, eat, and want to have sex again, then nortriptyline is the better drug. Hmm, there may be something to the hypothesis floating around that men respond better to TCAs and women to SSRIs.
Zoloft vs. Lexapro vs. Effexor vs. the brain-derived neurotrophic factor (BDNF) hypothesis of depression. A recent hypothesis of what causes depression and how meds fix it involves how much BDNF we have floating around and the effect meds have on it. The results: while all the depressed people in this study had lower amounts of BDNF than the professional guinea pigs healthy control subjects, the meds acted very differently. Zoloft increased it after five weeks, Effexor took somewhere around six months to change it, and Lexapro didn’t affect it at all. Yet all three were about equally effective in treating depression. So much for that idea.
6. How Lexapro (escitalopram) Compares with Other Drugs for Off-Label Treatments
Lexapro vs. Paxil for Social Anxiety Disorder (SAnD). This Lundbeck-sponsored study isn’t very fair, as it compares 20mg of the older, immediate-release Paxil against 5mg, 10mg, and 20mg of Lexapro. While 20mg of immediate-release Paxil is GSK’s recommendation for SAnD, it’s 25–37.5mg a day for the controlled-release flavor. While 10mg of Lexapro is equal to 10mg of Paxil, 20mg of Lexapro is more like 37.5mg of Paxil CR. So it’s not all that surprising that 20mg of Lexapro was more effective than 20mg of Paxil.
Lexapro vs. Celexa vs. Placebo for Panic disorders. Panic disorders are off-label for Celexa as well. The results - Lexapro and Celexa are both really good for panic, and Lexapro sucks less than the placebo. This sort of thing shows up in a lot of Lexapro studies and clinical trials: “The rate of discontinuation for adverse events was 6.3% for escitalopram, 8.4% for citalopram, and 7.6% for placebo.”
Lexapro vs. Celexa vs. Placebo for Panic disorders - the sequel. The results - Lexapro kicked Celexa’s ass, which is something you don’t see very often. This was done by DJ Stein, who is one of Lundbeck’s favorite researchers, so he could have set it up to slant things in Lexapro’s favor. The abstract isn’t very forthcoming in results: “Treatment with escitalopram was associated with significant improvement on all 5 subscales of the P&A. Citalopram was significantly different from placebo in 3 subscales. […] Escitalopram was superior to placebo on 12 of 16 items of the Q-LES-Q, while citalopram was superior on 7 items.” Unlike Dr. Stahl’s study above, there’s no hint in the abstract as to what “significant” means.
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1 Assuming you were correctly diagnosed in the first place.
2 Keep in mind that according to one study, most drug studies will skew in favor of the med made by the company that sponsored the study.* That's one of my favorite "no shit Sherlock" studies, although it did help in getting conflicts of interest showing up on papers. Two additional papers along similar lines are Why Current Publication Practices May Distort Science** and Why Most Published Research Findings Are False***. So in addition to the books we use as source material, this is why we also factor a lot of anecdotal evidence (personal experience, experiences of people we know, case reports, what people have sent us in e-mail, and what is posted all over the Internet) into our conclusions regarding the likelihood of meds working, the prevalence of various side effects, etc. While the drug companies are getting a lot more transparent and publishing more data in the PI sheets regarding the results of the clinical trials, they still don't publish how many times a drug failed a clinical trial.****
3 The data are often contradictory when compared with Celexa. Celexa averages 60-70% for both response and remission, while Lexapro is often in the neighborhood of 70-75%; hence the big spread on the response rate that seems a bit low given the results of a lot of studies, trials, and anecdotal evidence.
4 Most of the time at any rate. There's always an outlier study or two, as you'll see if you keep reading this page.
Lexapro is a trademark of someone else. Look on the the PI sheet or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on the Crazy Meds Forum.
The information on Crazy Meds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Know your sources! Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazy Meds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazy Meds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazy Meds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazy Meds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality.
‘Everything is true, nothing is permitted.’ - Jerod Poore
1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internetis a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]